Provider Demographics
NPI:1467040931
Name:ROSALES, JOSEPH LUIS (RN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LUIS
Last Name:ROSALES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 E DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8411
Mailing Address - Country:US
Mailing Address - Phone:928-710-2910
Mailing Address - Fax:
Practice Address - Street 1:8171 E DEBBIE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8411
Practice Address - Country:US
Practice Address - Phone:928-710-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169939163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical